Regional differences in the intranodal distribution of tumor cells.

The intranodal distribution of tumor cells was examined in 103 mesenteric and 135 axillary nodes to determine the frequency of a circumferential type of distribution and its relationship, if any, to central necrosis. Eighteen percent of the mesenteric nodes removed at surgery from patients with colon cancer contained a circumferential rim of viable tumor cells in an area corresponding wholly or in part to the normal location of the marginal sinus. In each case this rim of tumor cells surrounded a large central area of necrosis. In contrast, only one of the 135 axillary nodes removed from patients with breast cancer demonstrated this pattern. These findings suggest that by interrupting blood and lymph vessels, the circumferential spread of tumor cells underlies development of central necrosis. Previously described structural dissimilarities between mesenteric and axillary nodes may explain the striking difference in incidence of this pattern in these nodes.

Interstitial albumin-bound dye concentrations in mice with a protein-rich effusion.

Levels of intravenously injected Evans blue dye in eluates of the lung and kidney, an index of interstitial fluid albumin concentration, together with water content of these tissues and levels of serum albumin were measured in Ha-icr mice with a tumor cell-induced protein-rich peritoneal effusion. By the fourth day after the intraperitoneal injection of tumor cells, when mean serum albumin levels had fallen to 76% of control values, mean albumin bound dye concentrations in lung and kidney had decreased to 63 and 58%, respectively, of control values. By the tenth day when serum albumin levels had decreased further to 67% of control values, albumin-bound dye concentrations in the lung and kidney had decreased to 58 and 43%, respectively, of control values. During this 10-day period the water content of the lung remained unchanged whereas that of the kidney had decreased by 7%. These observations suggest that the reduction in serum albumin which results from an abnormal distribution of this protein into a nonvascular compartment is accompanied, as in other models of hypoalbuminemia, by a more than proportionate reduction in interstitial albumin concentration in the lung and kidney.

Thoracic duct lymph in a patient with chylous ascites and a carcinoid tumor.

An adult patient with both intraabdominal carcinoid tumor and chylous ascites underwent thoracic duct drainage in an attempt to relieve accumulation of intraabdominal fluid. After cannulation of the left cervical thoracic duct, lymph flow rate was normal (1.4ml/min) and 24 hours of drainage was without effect on the ascites. In contrast to the chylous nature of the ascitic fluid, however, thoracic duct lymph was non-chylous and its protein content was lower than that of the ascitic fluid. The administration of secretin intravenously increased both the flow and amylase content of thoracic duct lymph. These observations signify that the chylous ascitic fluid neither leaked from nor had access to thoracic duct lymph but originated instead from obstructed mesenteric lacteals.

Thrombocytopenic purpura in parenteral drug abusers.

Twenty heterosexual men considered to be at risk for developing the acquired immunodeficiency syndrome because of parenteral drug abuse underwent splenectomy for steroid resistant thrombocytopenia during a recent 34 month period. Increased bruising, ecchymoses petechiae and occasional epistaxis, together with markedly elevated levels of platelet associated immunoglobulin, were characteristic findings. There was no operative mortality, and the morbidity rate was 25 per cent. Accessory spleens were removed in five patients. Platelet counts rose to normal levels or higher postoperatively in all patients, and this response was sustained for one month to 25 months in 13 of 15 patients for whom this information is available. Thrombocytopenia in parenteral drug abusers can be safely and promptly corrected by splenectomy, and although more information is needed, it seems likely that this response will be maintained in most of these patients.

Lymph node siderosis in trypan blue treated rats.

The accumulation of iron in the lymph nodes of trypan blue treated rats was examined as a possible experimental counterpart of the lymph node siderosis which occurs in patients with Hodgkin's disease. Lymph nodes removed from the hilus of the liver, retrosternal area, axilla and root of the small bowel mesentery were examined histologically for iron in rats receiving 6-20 subcutaneous injections of trypan blue at biweekly intervals and in control rats. An increase in erythrophagocytosis accompanied by a progressive increase in the amount of stainable iron was found in the RE cells of nodes located in the lymphatic outflow tract of the liver. As in patients with Hodgkin's disease, an increase in erythrophagocytosis together with the prolonged retention of iron by RE cells appears to account for the accumulation of iron in the lymph nodes of trypan blue treated rats.

Resistance to peritonitis following disruption of peritoneal mast cells.

A single ip injection of distilled water osmotically disrupts almost the entire population of peritoneal mast cells in rats. The metachromatic granules released from disrupted mast cells are phagocytosed by peritoneal macrophages increasing their chemotactic and spreading activities. On this basis a study was carried out to determine whether an ip injection of distilled water, by releasing an abundance of these granules for peritoneal macrophage stimulation, protects rats subsequently exposed to peritonitis. We found that a single ip injection of distilled water lowers the mortality in rats exposed to bacterial peritonitis 2-3 weeks later from 80 to 33%.

Significance of an enlarged splenic artery in patients with splenic vein thrombosis.

In an attempt to determine the relationship, if any, between the size of the splenic artery and various clinical aspects of splenic vein thrombosis, including splenomegaly, the clinical and angiographic findings in ten patients with this disorder were reviewed. The size of the splenic artery was found to be unrelated to the nature of the underlying disease, age of the patient, or history of variceal bleeding. An abnormally wide and tortuous splenic artery was identified only in those patients (five) in whom there was also radiographic evidence of splenic enlargement. Since the angiographic finding of an enlarged and tortuous splenic artery is known to correlate closely with increased flow in this vessel, this observation suggests that in patients with isolated splenic vein obstruction an increase in splenic artery flow accompanies splenic enlargement and is probably a critical component of the underlying derangement.

Increased survival from peritonitis after blockade of transdiaphragmatic absorption of bacteria.

Based upon the knowledge that bacteria in the peritoneal cavity gain access to circulating blood by way of transdiaphragmatic absorption into lymph, a study was carried out to determine whether this absorption protects or endangers the host. Blockade of absorption produced by intraperitoneal (IP) injection of platelet rich plasma (PRP) or by scarification of the peritoneal surface of the diaphragm increased survival time in rats with double colonic perforation from 20 per cent in control rats to 86 and 93 per cent, respectively. Each of these maneuvers significantly increased the number of negative blood culture findings.

Regeneration-induced lengthening of the cut ends of the rat colon.

The transected colon was studied in rats in an attempt to determine whether the regenerating cut ends could be induced to lengthen by delaying or preventing their spontaneous reattachment. When the two cut ends of the defunctionalized colon were separated by a 2-3-cm length of silastic tubing mucosal, luminal and serosal continuity across the gap was restored in 8-10 weeks. Cannulation of one cut end with silastic tubing so placed as to extend 2-3 cm beyond the cut end led to lengthening of the intestine over the exposed end of the tubing by 20 weeks. The area subadjacent to regenerated mucosa filled initially with granulation tissue which was gradually replaced by loose connective tissue containing at times a thin layer of smooth muscle.

Experimental models of splenic dysfunction.

Animal simulations of splenic disorders are described including alterations in portal and splenic vein flow, induction of splenic sequestration, models of hyposplenism and murine hereditary spherocytosis.

The intranodal distribution of lymph-borne particles injected intravenously.

The sequential distribution of lymph-borne, i.v. injected particles of tantalum in hepatic hilar lymph nodes was studied in rats in an attempt to determine which structural compartments of a node are responsible for mechanical filtration. The injected particles reached these nodes via liver lymph but the i.v. route of administration eliminated any possibility of disturbing either lymph flow or pressure. Particles began to enter hepatic hilar nodes only after an interval of 7-8 h. They were subsequently redistributed from marginal, trabecular and medullary sinuses to the paracortex and finally to medullary cords. Particles accumulated predominantly in the paracortex at 12-24 h and thereafter in medullary cords. This sequential pattern of distribution differed significantly from that observed previously in other lymph nodes after either intralymphatic or intratissue injection.

Transmural fluid movement in the freshly excised human gallbladder.

Direct information concerning the incidence and nature of gallbladder dysfunction in symptomatic cholethiasis was obtained by examining the rate and direction of transmural fluid movement in the freshly excised gallbladder. Each specimen was emptied of bile, cannulated and filled with a measured volume of bicarbonated Ringer's solution, suspended in the same solution at 37 degrees C., gassed with 95 per cent oxygen and 5 per cent carbon dioxide and weighed at ten minute intervals for at least one hour. Of the 42 human gallbladders examined, concentrating activity, ranging from 1 to 20 per cent of intraluminal volume per hour, was found in 14 and no activity in 17. Direction of fluid transport was found to be completely reversed in 12 additional gallbladders, four of which presented as hydrops. Histologic alterations ranged from mild to severe and could not be correlated with functional status. Application of indomethacin to the solution bathing both surfaces of 13 nonfunctioning, or partially functioning, gallbladders restored or increased function in eight. It can be concluded from this study that the concentrating activity is retained in approximately 30 per cent of patients with symptomatic cholelithiasis; cholesterol stones form in gallbladders with normal concentrating activity; the spectrum of gallbladder dysfunction ranges from simple loss of concentrating activity to hydrops, the latter reflecting complete loss of this activity plus secretion into the lumen, and dysfunction is probably induced by chemical mediators of inflammation rather than by structural changes.